We re searching for a Compliance Specialist to assist and support the Compliance and Privacy Director with the compliance functions of the organization to include (1) analyzing regulations related to healthcare compliance and helping to ensure the organization complies with these regulations; (2) auditing and monitoring to ensure compliance with healthcare regulations; (3) perform compliance and privacy investigations under the direction of the Compliance/Privacy Director; (4) assist in strengthening the compliance risk and controls framework, including the design and implementation of key risk indicators, tools and systems, processes and controls (5) oversee sanction screening, and (6) assist with compliance training and communications
The Compliance Analyst will be involved with operational functions of the core elements of the organization's compliance functions and work with Compliance/Privacy Director on matters needing escalation and resolution. This position will also assist the Compliance/Privacy Director in preparing for the (1) Finance, Audit and Compliance Committee and (2) the Enterprise Risk Management Committee. This role will need to be able to interface cross-functionally across the organization, especially by providing compliance support to revenue cycle.
- Maintain a working knowledge of relevant laws, rules, and regulations governing healthcare regulatory compliance (i.e., CMS, OIG, etc.) governing healthcare regulatory compliance and keeping abreast of current changes that may affect health care systems.
- Understanding of CMS regulations and Nebraska Department of Health and Human Services regulations.
- Stay current on relevant and emerging industry and government compliance program guidance, investigations, and audits; stay abreast of and provides updates regarding changes in legislation, regulations and other requirements that may result in organizational response.
- Provide oversight of regulatory compliance projects.
- Develop initial interpretation of relevant regulatory compliance regulations and guidelines.
- Develop expertise and perform research in compliance and issues as requested.
- Assist Compliance/Privacy Director with inspections, audit responses and consult on root cause analysis, as required.
- Assist in implementation of overall Compliance Plan and Code of Conduct; consult and provide guidance on a regular basis on related issues with operations directors/managers to ensure conformance with applicable laws and regulations.
- Develop presentations for the Compliance Management Committees and work groups.
- Assist in periodic reviews and revisions of the Compliance policies and procedures.
- Assist the Compliance/Privacy Director with other duties, as assigned.
- Assist in developing metrics to evidence compliance effectiveness.
- Assist in documentation of compliance activities.
Internal Investigations & Reviews
- Work with the Compliance/Privacy Director to appropriately investigate and remediate allegations of improper/illegal activities.
- Perform and document internal investigations in accordance with applicable legal requirements and organizational policies and procedures.
- Investigate alleged HIPAA breaches and recommend appropriate corrective action plans.
- Investigate incidents, document findings; oversee completion of corrective actions plans.
Compliance Education & Training
- Support the compliance training programs on a day-to-day basis.
- Research and author educational materials.
- Provide compliance educational and training offerings.
- Compile, analyze and integrate reports, spreadsheets, benchmarks, data and metrics for continuous improvement of the Compliance Program functions, productivity, and outcomes; develop tools, forms, and educational materials to improve organizational Compliance Program performance.
Auditing & Monitoring
- Identification of focus areas by the OIG and other regulatory bodies to assist in forming the compliance work plan.
- Perform compliance risk assessments, under the direction of the Compliance/Privacy Director, including development and completion of action plans to address findings.
- Assist with auditing and monitoring to ensure compliance with all federal, state & local regulations, as well as fiduciary requirements, and identify areas of vulnerability and risk.
KNOWLEDGE, SKILLS AND ABILITIES
- Ability to manage difficult, sensitive and confidential situations with integrity and professionalism.
- Strong interpersonal skills; able to deal effectively with diverse skill sets and personalities.
- Excellent analytical, problem-solving, and decision-making skills.
- Highly organized with proven ability to prioritize workload, meet deadlines, and manage several projects at one time.
- Possess a high degree of flexibility to respond rapidly to changing goals, ability to work under pressure, and meet deadlines.
- Must be detail oriented and take initiative to learn new tasks.
- Excellent verbal and written communication skills.
- Excellent writing, editing and proofreading skills.
- Executes all job responsibilities and assignments promptly, reliably, honestly and ethically.
- Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint), including creating charts and graphs.
EDUCATION AND EXPERIENCE
- A bachelor's degree is required.
- Judicial Doctorate (JD) degree preferred.
- 3 years in a healthcare compliance function is required.
- Healthcare billing and understanding of CMS regulations is preferred.
- Certification in Healthcare Compliance (CHC) from the Health Care Compliance Association (HCCA) is required within one-year of hire.
Children's Hospital & Medical Center - Omaha